Objectives: To study the prevalence of medically compromised conditions in patients seeking dental treatments at the Faculty of Dentistry, Chulalongkorn University. Study design: The fi les of 58,317 patients seeking dental treatments at the Faculty of Dentistry, Chulalongkorn University from 2002-2004 were retrieved and reviewed for medically compromised conditions. Results: From a total of 58,317 patients, 7,167 patients (12.2%) had medically compromised conditions. The fi ve most prevalent conditions in descending order were allergy, hypertension, diabetes mellitus, heart diseases and thyroid diseases. Conclusions: Even though the prevalence of medically compromised conditions in dental patients is not high, dentists should bear in mind that some of the patients may harbor such conditions which are contraindicated for certain dental procedures or medication or require special attention when treating these patients. Therefore, a thorough history taking and careful clinical examinations are mandatory before commencing any dental treatment

Bijaphala,Panruthai

Dhanuthai,Kittipong

Kulvit,Sirinya

Sappayatosok,Kraisorn

Sereerat,Thanasit

English

Repositori d'Objectes Digitals per a l'Ensenyament la Recerca i la Cultura

E287Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14 (6):E287-91.                                                                                                                                                         Medically compromised conditionsJournal section: Oral Medicine and PathologyPublication Types: ResearchPrevalence of medically compromised conditions in dental patientsKittipong Dhanuthai 1, Kraisorn Sappayatosok 2, Panruthai Bijaphala 3, Sirinya Kulvit 3, Thanasit Sereerat 41 Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand2 Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand3 Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand4 Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, ThailandCorrespondence: Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University. Henri Dunant Rd, Pathumwan District, Bangkok 10330. Thailand, fi broma123@yahoo.com.Received: 10/06/2008Accepted: 16/11/2008Dhanuthai K, Sappayatosok K, Bijaphala P, Kulvitit S, Sereerat T. Preva-lence of medically compromised conditions in dental patients. Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14 (6):E287-91.    http://www.medicinaoral.com/medoralfree01/v14i6/medoralv14i6p287.pdfAbstractObjectives: To study the prevalence of medically compromised conditions in patients seeking dental treatments at the Faculty of Dentistry, Chulalongkorn University. Study design: The fi les of 58,317 patients seeking dental treatments at the Faculty of Dentistry, Chulalongkorn University from 2002-2004 were retrieved and reviewed for medically compromised conditions. Results: From a total of 58,317 patients, 7,167 patients (12.2%) had medi-cally compromised conditions. The fi ve most prevalent conditions in descending order were allergy, hypertension, diabetes mellitus, heart diseases and thyroid diseases. Conclusions: Even though the prevalence of medically compromised conditions in dental patients is not high, dentists should bear in mind that some of the patients may harbor such conditions which are contraindicated for certain dental procedures or medication or require special attention when treating these patients. Therefore, a thorough history taking and careful clinical examinations are mandatory before commencing any dental treatment.Keywords: Medically compromised conditions, prevalence, dental patients.Article Number: 5123658883            http://www.medicinaoral.com/© Medicina Oral S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946eMail:  medicina@medicinaoral.com Indexed in: -SCI EXPANDED-JOURNAL CITATION REPORTS-Index Medicus / MEDLINE  /  PubMed                       -EMBASE, Excerpta Medica-SCOPUS-Indice Médico Español                                                        IntroductionThe advances in medical technology, greater access to medical facilities and better socio-economic conditions enable people to live longer as evidenced by an increase in the life expectancy in many parts of the world (1). These improvements are also refl ected in better oral health in a number of patients since they still retain their natural teeth into the old age. As a consequence, dentists are expected to encounter a greater number of patients, especially the elderly. As the proportion of the elderly in the population continues to increase, there will be more patients with medically compromised conditions. When dentists have a chance to treat these patients, there are concerns that they should be aware of such as the ef-fect of medical problems and their treatments on dental treatment plans, the dental or oral soft tissue problems that can arise in these patients and the effect of dental treatments on their medical conditions.There is a paucity of data concerning the prevalence of medically compromised conditions in dental patients from Thailand. To the best of our knowledge, there is only one small-scale study from one dental school in Bangkok (2). The objective of this study was to deter-mine the prevalence of medically compromised condi-tions in Thai dental patients.E288Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14 (6):E287-91.                                                                                                                                                        Medically compromised conditionsMaterials and MethodsA total of 58,317 patient records from the Faculty of Dentistry, Chulalongkorn University starting from 1st January  2002 to 31st December 2004 were reviewed for the presence of medically compromised conditions. Demographic data of the patients were also collected. Medically compromised conditions were classifi ed into 8 categories as follows; allergy, endocrine disorders, cardiovascular diseases, respiratory diseases, hemato-logical disorders, liver diseases, renal diseases, and oth-ers. The age of the patients was analyzed by descriptive statistics. Chi square was used to determine difference between genders.  A p-value less than 0.05 was consid-ered statistically signifi cant.ResultsFrom a total of 58,317 patients, 7,167 patients (12.2%) were affl icted with medically compromised conditions. The age of dental patients who were affl icted with medi-cally compromised conditions ranged from 1 to 95 years with the mean age ±SD = 49.6  ± 17.25 years. The major-ity of them (54.3%) were in the 5th to the 7th decades of life (Fig.1). If each category was considered separately, the mean ages of the patients were in the 4th to the 6th decades of life (Table 1). There were 2,579 male patients (35.98%) and 4,588 female patients (64.02%). The number of female patients who had medically compromised con-ditions was statistically higher than that of male patients (p=0.000). Almost all categories elicited female predi-lection over male patients except in the respiratory dis-eases and liver diseases category. But, only in the allergy, cardiovascular diseases, endocrine disorders and hema-tologic disorders categories, that female patients signifi -cantly outnumbered male patients (Table 1).In the present study, the most frequently encountered disease category was allergy followed in descending order by cardiovascular diseases, endocrine disorders, respiratory diseases, hematological disorders, liver dis-eases, others and renal diseases, respectively (Fig.2).In the allergy category, 14.33% of them were allergic rhinitis while the rest were allergy to drugs. Most pa-tients were allergic to penicillin followed by sulfa group, tetracycline and aspirin respectively.DiscussionThe category which exhibited the highest mean age was the cardiovascular diseases category followed by the endocrine diseases category. This refl ects the character of these 2 categories which are usually encountered in adult or elderly patients, while the hematologic disor-ders category showed the lowest mean age since some hematologic disorders are congenital abnormalities and can be found at birth or during childhood. The present study demonstrated female preponderance in almost all categories even in the generally accepted male predominance diseases such as cardiovascular dis-eases. This phenomenon may be attributable to the fact that females pay more attention to both general health and oral health than males as evidenced by the greater number of female patients attending Chulalongkorn dental school (female: male ratio=1.5:1)The prevalence of medically compromised conditions in dental patients in the present study was 12.2%. This fi g-ure is rather low when compared with previous studies. Rhodus et al. (3). reported that the prevalence of medi-cal conditions in dental patients increased from 7.3% in 1976 to 24.6% in 1986. Smeets et al. (4). revealed the prevalence of medically compromised patients from the survey of 29,424 dental patients from the Netherlands to be 28.2%. Saengsirinavin et al. (2). disclosed the preva-lence of medical conditions in Thai dental patients to be 55.45%. Umino et al. (5) reported that one or more medically compromised conditions were encountered in 64.2% of elderly Japanese dental patients.  Cottone et al. (6) conducted a survey from 4,365 patients and the result indicated that 68.5% of the patients had at least one signifi cant medical problem. Nery et al. (7) reviewed 581 periodontal patients’ records. The results revealed that the private offi ce group had 27.6% medical problems, the academic dental center had 46.3%, while Medically compromised conditions Age (mean ± SD) Number ofM:FChi squarefor gender difference(p-value)Allergy 39.68 ± 16.86 1212 : 2526 0.000Cardiovascular diseases 56.54 ± 14.22 956 : 1405 0.000Endocrine diseases 52.73 ± 14.27 434 : 852 0.000Respiratory diseases 44.89 ± 23.65 288:188 0.208Hematologic disorders 31.42 ± 18.38 53 : 166 0.002Liver diseases 39.84 ± 14.24 101 : 89 0.835Renal diseases 45.18 ± 16.84 26 : 42 0.317Others 39.28 ± 17.71 71 : 94 0.371Table 1. Age and gender of medically compromised dental patientsE289Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14 (6):E287-91.                                                                                                                                                         Medically compromised conditions Fig. 1. The age distribution of dental patients who were affl icted with medically compromised conditions.  Fig. 2. The distribution of medically compromised conditions in dental patients.E290Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14 (6):E287-91.                                                                                                                                                        Medically compromised conditionsthe hospital dental clinic showed the highest prevalence of 74.1%. The reasons for this may be accounted for by the fact that the present study recruited patients across a wide age range in contrast to most previous studies which focused exclusively on elderly patients since the prevalence of medically compromised conditions tends to increase with advancing age (8,9).  The majority of people in developing countries such as Thailand do not undergo routine medical check-ups.  As a consequence, patients harboring asymptomatic medically compro-mised conditions such as hypertension, heart disease or diabetes mellitus do not realize that they have medi-cally compromised conditions. The present study is a retrospective study conducted by reviewing the patient records. The major drawback of the present study is that it does not conduct the interview and physical examina-tions so patients with undiagnosed medically compro-mised conditions may go undetected. The other reason is that patients with infectious or sexually transmitted diseases such as AIDS may not give accurate medical histories for fear that they may be denied dental treat-ments. Surprisingly, there was a study from one den-tal school situated in the same Bangkok area reporting a prevalence of medically compromised conditions in dental patients as high as 55.4% (2). This unusual high prevalence may occur by chance since there were only 541 patients in that small-scale study.Allergy ranked as the most common medically compro-mised conditions encountered in dental patients in the present study. Similar fi ndings were reported by Saeng-sirinavin et al. (2) in a small-scale study from Bangkok area. The studies by Smeets et al. (4) and Suomi et al. (8) also indicated that allergy ranked as the most frequently encountered medically compromised conditions in den-tal patients.  In the present study, there were more drug allergy pa-tients than the allergic rhinitis patients and the most common drug that the patients were allergic to was penicillin followed by sulfa group as in the study by Jainkittivong et al. (10). The incidence of penicillin al-lergy has been reported to be from 1-10% (11). Dentists should take a thorough patient history especially drug allergy before prescribing any medication. In the present study, cardiovascular diseases came sec-ond as the most prevalent medically compromised con-ditions in dental patients as in the studies by Smeets et al. (4), Persson et al. (12), and Jainkittivong et al. (10). A number of previous studies reported that cardiovas-cular diseases were the most prevalent medically com-promised conditions in dental patients (3-7). Endocrine disorders, the majority of which were diabetes mellitus, came third in the present study. Allergy, cardiovascular diseases, and endocrine disorders are usually among the top fi ve most common medically compromised condi-tions in dental patients, but in different orders in dif-ferent studies (13). The other category that is always among the top fi ve most common medically compro-mised conditions in elderly dental patients is bone and joint disorders.As more and more patients with medically compro-mised conditions are seeking dental treatments, dentists should be prepared to handle this type of patient. A thor-ough history taking and physical examination in every patient is important to identify patients with medically compromised conditions, but unaware of them. There may be a modifi cation in treatment plan to suit individ-ual patient (14,15). For example, the fi rst six month after acute myocardial infarction, dental treatment should be reserved for emergency situation only (14) or the avoid-ance of bruising maneuvers during dental treatment in patients with coagulation factor defi ciency (16). Pre-scribing medications for this type of patient must be carried out with extra-care to avoid interference with multiple medications patients already have and an un-desirable drug interactions (15). Antibiotic prophylaxis is compulsory for certain dental procedures. Dental set-ting is regarded as a stressful environment for certain individuals. It would be benefi cial to reduce stress in the dental setting when treating this type of patient es-pecially in hypertensive patients (14). ConclusionsEven though the prevalence of medically compromised conditions in dental patients is not high, dentists should bear in mind that some of the patients may harbor medi-cally compromised conditions which are contraindi-cated for certain dental procedures or medications or required special attention when treating these patients. Therefore a thorough history taking and careful clinical examinations are mandatory before commencing any dental treatment.References1. Steel K. The elderly: the single greatest achievement of mankind. Disabil Rehabil. 1997;19:130-3. 2. Saengsirinavin C, Kraivaphan P, Phumara P. Survey of drug used and medical history among dental out-patients. J Dent Assoc Thai. 1990;40:68-74. 3. Rhodus NL, Bakdash MB, Little JW, Haider ML. Implications of the changing medical profi le of a dental school patient population. J Am Dent Assoc. 1989;119:414-6. 4. Smeets EC, De Jong KJ, Abraham-Inpijn L. Detecting the medi-cally compromised patient in dentistry by means of the medical risk-related history. A survey of 29,424 dental patients in The Nether-lands. Prev Med. 1998;27:530-5. 5. Umino M, Nagao M. Systemic diseases in elderly dental patients. Int Dent J. 1993;43:213-8. 6. Cottone JA, Kafrawy AH. Medications and health histories: a sur-vey of 4,365 dental patients. J Am Dent Assoc. 1979;98:713-8. 7. Nery EB, Meister F Jr, Ellinger RF, Eslami A, McNamara TJ. Prev-alence of medical problems in periodontal patients obtained from three different populations. J Periodontol. 1987;58:564-8. 8. Suomi JD, Horowitz HS, Barbano JP. Self-reported systemic con-ditions in an adult study population. J Dent Res. 1975;54:1092. E291Med Oral Patol Oral Cir Bucal. 2009 Jun 1;14 (6):E287-91.                                                                                                                                                         Medically compromised conditions9. Galan D, Brecx M, Mayer L. Medical status, functional status and drug utilization patterns of a population of older dental patients in Winnipeg, Manitoba. J Can Dent Assoc. 1997;63:29-33. 10. Jainkittivong A, Aneksuk V, Langlais RP. Medical health and medication use in elderly dental patients. J Contemp Dent Pract. 2004;5:31-41. 11. Da Fonseca MA. Adverse reaction to amoxicillin: a case report. Pediatr Dent. 2000;22:401-4. 12. Persson RE, Persson GR, Robinovitch M. Periodontal conditions in medically compromised elderly subjects: assessments of treatment needs. Spec Care Dentist. 1994;14:9-14. 13. Khader YS, Alsaeed O, Burgan SZ, Amarin ZO. Prevalence of medical conditions among patients attending dental teaching clinics in northern Jordan. J Contemp Dent Pract. 2007;8:60-7. 14. Margaix Muñoz M, Jiménez Soriano Y, Poveda Roda R, Sarrión G. Cardiovascular diseases in dental practice. Practical considera-tions. Med Oral Patol Oral Cir Bucal. 2008;13:E296-302. 15. Jover Cerveró A, Bagán JV, Jiménez Soriano Y, Poveda Roda R. Dental management in renal failure: patients on dialysis. Med Oral Patol Oral Cir Bucal. 2008;13:E419-26. 16. Jover-Cerveró A, Poveda Roda R, Bagán JV, Jiménez Soriano Y. Dental treatment of patients with coagulation factor alterations: an update. Med Oral Patol Oral Cir Bucal. 2007;12:E380-7.    

Prevalence of medically compromised conditions in dental patients

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Prevalence of medically compromised conditions in dental patients

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